Program Profile: Brief Strategic Family Therapy

This is a family-based intervention designed to prevent and treat youth behavior problems. The program is rated Promising. Intervention families showed a statistically significant greater likelihood of being engaged and retained in treatment, and intervention youth showed statistically significant greater improvement in conduct disorder and socialized aggression. There were no statistically significant differences in adolescent alcohol use or improved family functioning.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.

Program Goals/Target Population

Brief Strategic Family Therapy (BSFT) is a family-based intervention designed to prevent and treat child and adolescent behavior problems. The goal of BSFT is to improve a youth’s behavior by improving family interactions that are presumed to be directly related to the child’s symptoms, thus reducing risk factors and strengthening protective factors for adolescent drug abuse and other conduct problems. BSFT targets children and adolescents who are displaying—or are at risk for developing—behavior problems, including substance abuse.

Program Components

BSFT is based on the fundamental assumption that adaptive family interactions can play a pivotal role in protecting children from negative influences and that maladaptive family interactions can contribute to the evolution of behavior problems and consequently are a primary target for intervention. The therapy is tailored to target the particular problem interactions and behaviors in each client family. Therapists seek to change maladaptive family interaction patterns by coaching family interactions as they occur in session to create the opportunity for new, more functional interactions to emerge.

Major techniques used are joining (engaging and entering the family system), tracking and diagnosing (identifying maladaptive interactions and family strengths), and restructuring (transforming maladaptive interactions). Through the technique of joining, the therapist develops a therapeutic alliance with the family, one that gives due respect to each individual within the family as well as to the way the family is organized. As this working alliance is established, the therapist tracks and diagnoses family strengths, weaknesses, and patterns, which sets the foundation for the treatment plan. Restructuring or reframing techniques help the family reduce problematic relations and patterns, and instead develop mutually supportive and effective relations and patterns. Depending on the case, these techniques may include helping families develop effective behavior management skills, conflict resolution skills, or communications skills and helping parents learn parenting skills.

BSFT is a short-term, problem-oriented intervention. A typical session lasts 60 to 90 minutes and is held with the adolescent and one or more other family members. The average length of treatment is 12 to 16 sessions over a 3- to 4-month period. For more severe cases, such as substance-abusing adolescents, the average number of sessions and length of treatment may be doubled. Treatment can take place in the office, home, or community settings.

Study

Robbins and colleagues (2011) used a random assignment design at eight community treatment provider sites to assess the impact of Brief Strategic Family Therapy (BSFT) on family functioning and adolescent substance abuse. Therapists were randomly assigned to the treatment condition or to treatment as usual (TAU). Therapists who volunteered to participate in the study did not know in advance to which group they would be assigned. Drug use was assessed at baseline and at 12 monthly follow-up assessments. All other measures were assessed at baseline, then at 4, 8, and 12 months postrandomization. Other measures included family functioning and retention and engagement.

TAU varied across the eight community treatment providers. It included individual therapy, group therapy, parent training groups, nonmanualized family therapy, and case management. Participants received 12 to 16 sessions over a 3- to 4-month period. Participation in ancillary services (e.g., case management, Alcoholic Anonymous) was typical.

BSFT included 12 to 16 sessions over a 4-month period. Other systems could be addressed during these sessions (e.g., parents could be coached on how to communicate with a probation officer or a school official). Most sessions were delivered in either the home (52.2 percent) or the clinic (45.3 percent) but could also be delivered elsewhere, such as at school or work (2.5 percent). Participation in ancillary services was permitted (e.g., case management, Alcoholic Anonymous), but most sessions were classified as family therapy. Booster sessions were allowed for participants in either condition.

Families were recruited from eight community treatment centers. To be included in the study, adolescents had to self-report illicit drug use (other than alcohol or tobacco) within the past 30 days. They had to live with a family (any parent or guardian). Adolescents with pending criminal offenses were excluded to eliminate the possibility of participant incarceration. The urn randomization process was used to assign families to either the control or treatment condition. A total of 480 adolescents and their family members participated in the study across eight sites. Participants were predominately male (n = 377). The racial/ethnic breakdown consisted of 213 Hispanics/Latinos, 148 non-Hispanic whites, 110 non-Hispanic blacks, 5 American Indians/Alaskans, 2 Japanese/whites, 1 Persian, and 1 Lebanese. Seventy-two percent were referred from the juvenile justice system.

The statistical model used for analysis included random effects for site and therapists. Various methods were used to assess the differences in engagement and retention, drug use, and family functioning, such as logistic regression, contingency table methods, generalized estimating equations, and the Wilcoxon rank–sum test. The authors conducted subgroup analyses on race and gender in relation to treatment engagement and retention.

Study

Coatsworth and colleagues (2001) used an experimental pretest–posttest design with 104 families of Hispanic (n = 79) or African American (n = 25) descent. Families were eligible for the study if they had a 12- to 14-year-old child who had significant academic problems, had initiated drug or alcohol use, or about whom the family or school reported a complaint of externalizing problems in the form of misconduct or internalizing problems in the form of anxiety/depression. Adolescents who had attempted suicide were excluded from the study. The sample was 75 percent male, with a mean age of 13.1.

Participants were randomized to the experimental condition or the community comparison condition. The two groups did not significantly differ. The experimental group received BSFT, while the comparison group received whatever therapy the particular community agency used. Researchers assessed the adolescents’ behavior problems as well as engagement and retention in treatment at baseline and at the completion of treatment. The authors conducted subgroup analyses on conduct disorder intake scores in relation to treatment engagement and retention.

Study

Santisteban and colleagues (2003) used an experimental design to assess the efficacy of BSFT for Hispanic youth with behavior problems and drug use. A total of 126 Hispanic adolescents and their families participated in the study. To be eligible for inclusion, adolescents needed to exhibit externalizing behavior problems according to parents or school.

Adolescents ranged in age from 12 to 18. The majority of participants (87 percent) were male. The ethnic breakdown was 64 Cuban, 18 Nicaraguan, 12 Columbian, 8 Puerto Rican, 4 Peruvian, 2 Mexican, and 18 from other Hispanic nationalities. Youths were randomly assigned to either BSFT or a group treatment control (GC).

GC participants received a participatory-learning group intervention; facilitators led the group and encouraged participants to discuss and solve problems among themselves. The facilitator encouraged group cohesion, disseminated information regarding drug use, and maintained a problem-solving atmosphere. Groups consisted of four to eight adolescents; family members were not included. Participants received from 6 to 16 sessions of weekly therapy; sessions lasted on average 90 minutes.

Attrition for the BSFT condition was 30 percent and for the GC condition 37 percent. Adolescent behavior problems were assessed using the Revised Behavior Problem Checklist. Drug involvement was measured using the Addition Severity Index and urine toxicology screens. And family functioning was measured using the Family Environment Scale and the Structural Family Systems Rating. The researchers conducted subgroup analyses on family functioning and family cohesion at baseline.

Brief Strategic Family Therapy (BSFT) is delivered by certified therapists. The training program to become a therapist is offered by both the Family Therapy Training Institute of Miami (Fla.) and the Brief Strategic Family Therapy Institute of the University of Miami. For details on specific training courses and workshops, visit links to either provider found in the Program Snapshot.

In general, the training consists of workshops and a follow-up group or individual supervisions. Training covers the research evidence supporting the BSFT model, the philosophy of the model, and theoretical principles of the program.

Therapists learn that the patterns of interaction in a family are repetitive and predictable and that by carefully targeting those interactions the family can achieve lasting change. Specifically, therapists are taught how to engage with a family, diagnose the family’s interactions, and strategically restructure those who are proximal to the presenting problem behavior. Therapists are also instructed in BSFT specialized engagement techniques for engaging and retaining troubled youths and their families in treatment.

Certification is granted at the successful completion of the training. To continue practicing BSFT, a stringent recertification protocol is required.

Subgroup Analysis

Robbins and colleagues (2011) conducted subgroup analyses on race and gender in relation to treatment engagement and retention. There were no statistically significant differences in treatment engagement or retention between the Brief Strategic Family Therapy (BFST) group and the control group by race. Coatsworth and colleagues (2001) conducted subgroup analyses on conduct disorder intake scores in relation to treatment engagement and retention. The analyses revealed that within the BSFT group, families who had higher conduct disorder scores at intake were more likely to stay in treatment, compared with families who had lower scores at intake. In contrast, control group families who had lower conduct disorder scores at intake were more likely to stay in treatment, compared with control group families with higher scores at intake. These differences were statistically significant. Santisteban and colleagues (2003) conducted subgroup analyses on family functioning and cohesion scores at intake. They found that BSFT families who scored lower on family functioning at the baseline demonstrated greater improvement at the posttest, compared with control families who scored lower on family functioning. This difference was statistically significant.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Hervis, Olga E., Kathleen Shea, and S.M. Kaminsky. 2009. "Brief Strategic Family Therapy: Treating the Hispanic Couple Subsystem in the Context of Family, Ecology, and Acculturative Stress." In Volker K. Thomas and Mudita Rastogi (eds.). Multicultural Couples Therapy. California: Sage Publications.

Nickel, Marius K., Johannes Luley, Jakub Krawczyk, Cerstin Nickel, Christoph Widermann, Claas Lahmann, Moritz Muehlbacher, Petra Forthuber, Christian Kettler, Peter Leiberich, Karin Tritt, Ferdinand Mitterlehner, Patrick Kaplan, Francisco Pedrosa Gil, Wolfhardt K. Rother, and Thomas H. Loew. 2006. "Bullying Girls--Changes After Brief Strategic Family Therapy: A Randomized, Prospective, Controlled Trial With 1-Year Follow-Up." Psychotherapy and Psychosomatics 75:47-55.

Nickel, Marius K., Moritz Muehlbacher, Patrick Kaplan, Jakub Krawczyk, Wiebke Buschmann, Christian Kettler, Nadine Rother, Christoph Egger, Wolfhardt K. Rother, Thomas K. Loew, and Cerstin Nickel. 2006. "Influence of Family Therapy on Bullying Behaviour, Cortisol Secretion, Anger, and Quality of Life in Bullying Male Adolescents: A Randomized, Prospective, Controlled Study." Canadian Journal of Psychiatry 51:355-62.

Robbins, Michael S., Daniel J. Feaster, Viviana E. Horigian, Marc J. Puccinelli, Craig Henderson, and José Szapocznik. 2011. “Therapist Adherence in Brief Strategic Family Therapy for Adolescent Drug Abusers.” Journal of Consulting and Clinical Psychology 79(1):43–53.

Robbins, Michael S., and José Szapocznik 2000. "Brief Structural Family Therapy." Office of Juvenile Justice and Delinquency Prevention Bulletin. Washington, D.C.: Office of Juvenile Justice and Delinquency Prevention, Office of Justice Programs, U.S. Department of Justice.

Santisteban, Daniel A., José Szapocznik, Angel Perez–Vidal, William M. Kurtines, Edward J. Murray, and Arthur LaPerriere. 1996. "Efficacy of Intervention for Engaging Youth and Families Into Treatment and Some Variables That May Contribute to Differential Effectiveness." Journal of Family Psychology 10:35-44.

Szapocznik, José, William M. Kurtines, Franklin H. Foote, Angel Perez–Vidal, and Olga E. Hervis. 1986. “Conjoint Versus One-Person Family Therapy: Further Evidence for the Effectiveness of Conducting Family Therapy Through One Person.” Journal of Consulting and Clinical Psychology 54(3):395–97.

Szapocznik, José, Angel Perez–Vidal, Andrew L. Brickman, Franklin H. Foote, Daniel A. Santisteban, Olga E. Hervis, and William M. Kurtines. 1988. "Engaging Adolescent Drug Abusers and Their Families Into Treatment: A Strategic Structural Systems Approach." Journal Counseling & Clinical Psychology 56:552-57.

Szapocznik, José, Angel Perez–Vidal, Olga E. Hervis, Andrew L. Brickman, and William M. Kurtines. 1989. "Innovations in Family Therapy: Strategies for Overcoming Resistance to Treatment." In Richard A. Wells and Vincent J. Giannetti (eds.). Handbook of the Brief Psychotherapies. New York, N.Y.: Plenum Press, 93-114.

Szapocznik, José, Arturo T. Rio, and William M. Kurtines. 1991. "University of Miami School of Medicine: Brief Strategic Family Therapy for Hispanic Problem Youth." In Larry E. Beutler and Marjorie Crago (eds.). Psychotherapy Research: An International Review of Programmatic Studies. Washington, D.C.: American Psychological Association, 123-32.

Szapocznik, José, Arturo T. Rio, Edward J. Murray, Raquel Cohen, Mercedes A. Scopetta, Ana Rivas–Vasquez, Olga E. Hervis, and Vivian Posada. 1989. "Structural Family Versus Psychodynamic Child Therapy for Problematic Hispanic Boys." Journal of Consulting and Clinical Psychology 57(5):571-78.

Szapocznik, José, and Robert A. Williams. 2000. "Brief Strategic Family Therapy: 25 Years of Interplay Among Theory, Research, and Practice in Adolescent Behavior Problems and Drug Abuse." Clinical Child and Family Psychology Review 3(2):117-35.

Szapocznik, José, Olga Hervis, and Seth Schwartz. 2003. Therapy Manuals for Drug Addiction: Brief Strategic Family Therapy for Adolescent Drug Abuse. Washington, DC: U.S. Department of Health and Human Services, National Institute of Health.

Santisteban, Daniel A., Loudes Suarez-Morales, Michael  S. Robbins, and José Szapocznik. 2006. "Brief Strategic Family Therapy: Lesson Learned in Efficacy Research and Challenges to Blending Research and Practice." Family Process 45(2):259-71.

Following are CrimeSolutions-rated programs that are related to this practice:

Family-based Treatment for Adolescent Delinquency and Problem Behaviors

In general family-based treatment practices consist of a wide range of interventions that are designed to change dysfunctional family patterns that contribute to the onset and maintenance of adolescent delinquency and other problem behaviors. This practice is rated Effective for reducing recidivism, and Promising for reducing antisocial behavior and substance use, and improving psychological functioning and school performance.

Evidence Ratings for Outcomes

	Crime & Delinquency - Multiple crime/offense types
	Mental Health & Behavioral Health - Externalizing behavior
	Drugs & Substance Abuse - Multiple substances
	Mental Health & Behavioral Health - Psychological functioning
	Education - Academic achievement/school performance

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?